Grateful

“I finally realized that being grateful to my body was key to giving more love to myself.”  (Oprah Winfrey)

Body Dysmorphic Disorder (BDD) is a mental health condition that causes people to have a persistent obsession with a perceived flaw in physical appearance (e.g., hair, skin, nose, chest, or stomach). It is a case of where normal appearance concerns become an obsession and begin to interfere with a person’s life.  The condition affects almost as many men as women and generally first surfaces in adolescence.

People with BDD spend hours focused on what they think is wrong with their looks. Many times a day, they check, fix, cover up, or ask others about their looks. In reality, a perceived defect may be only a slight imperfection or something other people don’t particularly notice. Like other medical problems, BDD ranges from relatively mild cases to more severe. The most common symptoms that afflict individuals with BDD are described below:

·        Aesthetic sensitivity Individuals with BDD believe that their appearance is highly important. They confuse attractiveness with happiness (e.g., “I can only be happy if my appearance improves"). People with BDD feel worried, stressed, and anxious about their looks almost all the time.

·        Appearance comparison Individuals with BDD frequently and silently compare their specific body parts with those of others (e.g., a more attractive sibling), often concluding that they are less attractive. The comparisons are associated with more body dissatisfaction particularly if the comparison is made to target persons who are considered more attractive.

·        BDD by proxy They also excessively worry about other persons’ appearances (e.g., spouse, child, or sibling).

·        Excessive focus Individuals with BDD overfocus on tiny details of their appearance rather than the “big picture” of how they look. They act as if they are being stared through binoculars. The excessive self-focus prevents them to see other aspects of their appearance. With BDD, people find it hard to stop thinking about the parts of their looks they dislike. They focus on specific things — like a pimple on their skin, or the shape or looks of their nose, eyes, lips, ears, or hands.

·        Imagined ugliness Individuals with BDD are completely convinced that their appearance flaws are real, and they believe that they look ugly, or deformed in some way when in fact they do not. As a consequence of this belief, approximately 27 to 76.4 percent of individuals with BDD seek cosmetic solutions for their concerns, including surgical, dermatological, and dental procedures. These procedures are usually not beneficial.

·        Impulse control Patients with BDD exhibit poor impulse control (e.g., being unable to resist the urge to undertake cosmetic surgery to "correct" perceived flaws). With BDD, a person feels the strong need to check their looks over and over. For example, they check their looks in a mirror, ask others how they look, or "fix" their looks many times a day.

·        Intrusive thoughts Individuals with BDD experience intrusive thoughts and/or images. They think about their real or perceived flaws for hours each day. They feel powerless over them. And they don't believe people who tell them that they look fine. They view themselves in terms of their imperfect appearance and assume that others must be doing the same.

·        Safety-seeking behaviors When they are physically close to a person who is perceived as more attractive, BDD individuals are more likely to resort to a safety-seeking, protective behavior, such as camouflaging the perceived defect, avoiding eye contact, or escaping the situation.

·        Suffering in secret BDD is often described as a silent disorder. In fact, patients with BDD often are too embarrassed to reveal their concern to anyone, or to seek psychiatric treatment for their appearance concerns. They may be concerned that others might consider them vain.

·        They are making fun of how I look This bias is known as referential thinking. Referential thinking consists of a false belief that other people take special notice of the imagined defect (e.g., “I am convinced that person is staring at my fat body”). People with BDD don't see their body as it really is, or as others see it. The flaws they focus on are things that others can hardly notice. They feel convinced they look ugly even though it's not true.

·        Try not to be seen Some people with BDD feel so bad about their looks they don't want to be seen. They may stay home; keep to themselves; or use makeup, hats, or clothes to cover up. Some people with BDD avoid looking in mirrors because it is so stressful.

What causes BDD? There is still much to learn about the exact causes of BDD. But experts believe that these things play a role:

·        Brain differences Some areas of the brain look and work differently in people with BDD.

·        Genes BDD may be partly inherited. It tends to run in families. BDD is not caused by anything the person or their parent did. It is a mental health condition that needs treatment. BDD is not a person's fault.

·        Serotonin It is a normal and necessary chemical found in the brain. A low supply of serotonin helps explain why BDD happens.

BDD stems from a variety of emotional, physical, and psychological issues that can interfere with the quality of day to day life. You may find:

• Avoidance of mirrors
• Not allowing your picture to be taken
• Repeatedly combing your hair, shaving or engaging in other grooming activities
• Repeatedly touching, checking, or measuring the perceived flaw
• Wearing excessive makeup or growing a beard soles to cover up the flaw
• Wearing certain types of clothing, likes hats and scarves soles to cover up the flaw
• Overexercising
• Constantly changing your clothes
• Making multiple doctor visits, especially to dermatologists
• Undergoing multiple medical procedures (e.g., plastic surgeries) to try to eradicate or minimize the perceived flaw (minor or imagined) – usually resulting in unsatisfactory results
• Constantly thinking about your appearance
• Seeking reassurance by repeatedly asking others for their opinion of how you look, yet not believing them when they say you look good
• Compulsively skin picking, using fingernails or tweezer to remove unwanted hair or blemishes
• Avoiding social situations, leaving the house less often or only going out at night to try to camouflage your appearance in the darkness
• Keeping obsessions and compulsions secret for fear of social stigma
• Suffering from emotional problems, including depression, feelings of disgust, low self-esteem, and anxiety
• Believing that others take special notice of your perceived flaw

There are two ways combined together that help in treating BDD. Cognitive-Behavioral Therapy (CBT) teaches patients to recognize irrational thoughts and change negative thinking patterns. CBT emphasizes the need to broaden the basis of self-worth to include factors other than appearance (e.g., talents, intelligence, and moral values).  Medicines that help serotonin work well are used to treat BDD. These are sometimes called Selective Serotonin Reuptake Inhibitors (SSRIs) [i]medicines.

A particular form of CBT, known as Exposure and Response Prevention (ERP), is often used to treat people with BDD. Exposure involves taking steps to confront situations that cause your irrational concerns. ERP teaches you to resist the urge to cover up that perceived flaw with makeup or clothing, how to stop seeking reassurance from others about your appearance, and how to decrease the amount of time you spend repeatedly checking your appearance.

“Body Dysmorphic Disorder affects 1.7% to 2.4% of the general population-about 1 in 50 people.” (Anxiety and Depression Association of America) [ii]

---

[i] The Food and Drug Administration (FDA) has approved these SSRIs: Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), and Sertraline (Zoloft).

 

[ii] Sources used:

·         “10 Faulty Thoughts That Occur in Body Dysmorphic Disorder “by Shahram Heshmat

·        “Body Dysmorphic Disorder (BDD)” by ADAA

·        “Body Dysmorphic Disorder” by Susan McQuillan

·        “Body Dysmorphic Disorder” Reviewed by: D'Arcy Lyness

 

·        “Selective serotonin reuptake inhibitors (SSRIs)” by Mayo Clinic